Sleep Apnea: What Is It?
Sleep Apnea is a common sleep disorder in which breathing stops temporarily during sleep. Pauses in breathing may last for over ten seconds and recur over five times per hour. Sleep apnea is usually associated with snoring and increased airway resistance. As the oxygen levels decrease, the brain senses the problem, and ultimately briefly awakens the individual to resume breathing. This is often accompanied by a loud gasping noise.
Sleep apnea is usually a chronic disorder which lasts for many years. When breathing appears to stop or become shallow, the sleeper comes out of a deep sleep and moves to a light sleep. This results in very poor quality sleep, resulting in excessive daytime sleepiness.
A General Summary of Sleep Apnea
Sleep apnea is usually undiagnosed in most patients. It can not be detected during a routine doctor appointment, and there’s no blood test to diagnose it. In fact most sufferers don’t even know they have it because it occurs during sleep. Often, it is the bed partner who is aware that there is a problem during sleep.
Obstructive Sleep Apnea
Obstructive Sleep Apnea (OSA) is the most common type of Sleep Apnea. With OSA, the airway is blocked, or obstructed, by extra tissue in the back of the throat. Weight gain and obesity are risk factors for OSA. Over 5-10% of the adult population is thought to have obstructive sleep apnea. Children with large tonsils or adenoids are also at risk for OSA.
Central Sleep Apnea (CSA) is another type of sleep apnea. It is less common than obstructive sleep apnea. It is a result of the brain and nerve signals failing to send the instruction to the muscles to breathe. The symptoms of CSA are similar to OSA. However, the causes are different. CSA is associated with certain medications, brain disorders and heart disorders.
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Sleep Apnea: An Overview
WHAT IS SLEEP APNEA?
Sleep apnea is defined as an interruption in breathing during sleep. Usually when we are awake and conscious, we are aware of our breathing process and we can control the rate and rhythm of breathing. During sleep, breathing is controlled by the respiratory brain centers. It is a totally involuntary action which can not be controlled by one’s will. In sleep apnea, there is interference in the normal regular breathing process during sleep.
WHAT IS OBSTRUCTIVE SLEEP APNEA?
By the word obstructive, it is meant that some part of the lumen of the respiratory tract is narrowed to such an extent that it partially or completely collapses and the breathing process is interfered or comes to a halt. It usually involves the throat region.
HOW COMMON IS OBSTRUCTIVE SLEEP APNEA?
Obstructive sleep apnea is a common condition. About 4% of adults are diagnosed withObstructive sleep apnea in America – about 1 in every 25 Americans. Obstructive sleep apneahas a high prevalence among the general population, despite that 80% of people with this disorder are left undiagnosed. This is because many people suffering from Obstructive sleep apnea are either unaware of their problem or neglect their condition and do not bother to complain whilst still facing the consequences of this disorder.
WHO SUFFERS FROM OBSTRUCTIVE SLEEP APNEA?
Though believed to be a disorder of the general population, Obstructive sleep apnea is seen more in overweight individuals. Nevertheless, it may also be seen in individuals of normal weight who have other anatomic findings. People who suffer from enlarged tonsils and adenoids, macroglossia (enlarged tongue) or abnormal positioning of the maxilla and mandible, are also prone to suffer fromObstructive sleep apnea. Recent studies have shown that Obstructive sleep apnea is also seen frequently in patients suffering from congestive heart failure. Alcohol use has also been documented as one of the risk factors for Obstructive sleep apnea.
DOES OBSTRUCTIVE SLEEP APNEA AFFECT CHILDREN ALSO?
Yes, Obstructive sleep apnea may affect children as well. Many studies have been conducted by comparing different child age groups for the presence of this disorder. Enlarged tonsils and adenoids along with obesity are contributing factors to acquire Obstructive sleep apnea in children.
HOW DO I KNOW THAT I’M SUFFERING FROM OBSTRUCTIVE SLEEP APNEA?
One can be suspicious of having Obstructive sleep apnea if he/she has the following signs and symptoms:
- Loud snoring which is usually unnoticed by the patient but disturbs the bedroom partner who complains to the patient and the doctor.
- Gasping and choking noises during sleep.
- Disrupted sleep with frequent awakenings.
- Frequent nightmares (especially in children).
- Dry mouth, sore throat or headache after waking up in the morning.
- Excessive daytime sleepiness.
- High blood pressure.
DOES OBSTRUCTIVE SLEEP APNEA LEAD TO OTHER PROBLEMS?
Besides badly altering the quality of life, Obstructive sleep apnea gives rise to a number of moderate to severe medical conditions like Hypertension, Angina, Nocturnal cardiac arrhythmias, Myocardial infarction, Stroke, Emotional problems, Depression, Mood disorders, Poor memory, Irritability and motor vehicle accidents due to daytime drowsiness.
WHICH TESTS SHOULD BE DONE TO CONFIRM OBSTRUCTIVE SLEEP APNEA?
Though physical examination of the throat and weight measurement provide much information, following tests should be done to confirm whether you have Obstructive sleep apnea or not:
- Nocturnal polysomnography (over night sleep study) is the gold standard test done to evaluate Obstructive sleep apnea in patients. It involves monitoring of different events occurring during sleep like eye movements, chest wall movements and EEG etc.
HOW TO TREAT OBSTRUCTIVE SLEEP APNEA?
Treatment of Obstructive sleep apnea largely depends upon the severity of disease and also varies greatly from one individual to another. For mild cases of Obstructive sleep apnea, conservative measures are applied like:
- Weight loss therapy in case of obese patients, is an important treatment option and may results in improvement of symptoms in many patients.
- Sleeping in lateral positions (sleeping on the sides).
- Avoiding alcohol 4-6 hours before bedtime.
- Quitting smoking.
- Avoiding sleep medications.
If above measures fail or if the disease is severe, then Obstructive sleep apnea requires specific treatment which consists of following measures:
- Nasal continuous positive airway pressure (CPAP): This is the most effective treatment ofObstructive sleep apnea and has become the standard of care. It consists of a nasal mask which keeps the airway patent by providing positive air pressure into the airway.
- Oral and dental appliances: These devices work by manipulating the jaw bone in such a manner that it enlarges the posterior airspace.
- Oral Surgery: These surgeries are aimed at widening the airway by removing excess soft tissue from the throat or by removing enlarged tonsils and adenoids if they are the cause. Uvulopalatopharyngoplasty (UPPP) is one of the common surgeries.
- Laser assisted removal of soft tissues has also recently gained popularity among patients and doctors.
Most patients with Obstructive sleep apnea can be treated effectively by one of the above methods of treatment, but some may require more than one modality of treatment.